title: Prestroke weight loss is associated with poststroke mortality among men in the Honolulu-Asia Aging Study.
abstract: OBJECTIVE
  To examine baseline prestroke weight loss and poststroke mortality among men.
  
  
  METHODS
  Longitudinal study of late-life prestroke body mass index (BMI), weight loss, and BMI change (midlife to late life) with up to 8-year incident stroke and mortality follow-up.
  
  
  METHODS
  Community-based aging study data.
  
  
  METHODS
  Japanese-American men (N=3581; age range, 71-93y) who were stroke free at baseline.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Poststroke mortality: 30 days poststroke, analyzed with stepwise multivariable logistic regression; and long-term poststroke (up to 8y), analyzed with stepwise multivariable Cox regression.
  
  
  RESULTS
  Weight loss (4.5kg decrements) was associated with increased 30-day poststroke mortality (adjusted odds ratio=1.48; 95% confidence interval [CI], 1.14-1.92), long-term mortality after incident stroke (all types, n=225; adjusted hazards ratio (aHR)=1.25; 95% CI, 1.09-1.44), and long-term mortality after incident thromboembolic stroke (n=153; aHR=1.19; 95% CI, 1.01 to 1.40). Men with overweight/obese late-life BMI (≥25kg/m(2), compared with healthy/underweight BMI) had increased long-term mortality after incident hemorrhagic stroke (n=54; aHR=2.27; 95% CI, 1.07-4.82). Neither desirable nor excessive BMI reductions (vs no change/increased BMI) were associated with poststroke mortality. In the overall sample (N=3581), nutrition factors associated with increased long-term mortality included the following: (1) weight loss (10lb decrements; aHR=1.15; 95% CI, 1.09-1.21), (2) underweight BMI (vs healthy BMI; aHR=1.76; 95% CI, 1.40-2.20), and (3) both desirable and excessive BMI reductions (vs no change or gain, separate model from weight loss and BMI; aHR range, 1.36-1.97; P<.001).
  
  
  CONCLUSIONS
  Although obesity is a risk factor for stroke incidence, prestroke weight loss was associated with increased poststroke (all types and thromboembolic) mortality. Overweight/obese late-life BMI was associated with increased posthemorrhagic stroke mortality. Desirable and excessive BMI reductions were not associated with poststroke mortality. Weight loss, underweight late-life BMI, and any BMI reduction were all associated with increased long-term mortality in the overall sample.
authors.affiliation: The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI. Electronic address: bellcl@hawaii.edu.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Bell
authors.affiliation: Department of Health Sciences and Gerontology Research Centre, University of Jyvaskyla, Jyvaskyla, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Rantanen
authors.affiliation: Kuakini Medical Center, Honolulu, HI.
authors.forename: Randi
authors.initials: R
authors.lastname: Chen
authors.affiliation: Clinical Research Program, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI.
authors.forename: James
authors.initials: J
authors.lastname: Davis
authors.affiliation: The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; Veterans Affairs Pacific Islands Health Care System, Honolulu, HI; Pacific Health Research and Education Institute, Honolulu, HI.
authors.forename: Helen
authors.initials: H
authors.lastname: Petrovitch
authors.affiliation: The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; Veterans Affairs Pacific Islands Health Care System, Honolulu, HI; Pacific Health Research and Education Institute, Honolulu, HI.
authors.forename: G Webster
authors.initials: GW
authors.lastname: Ross
authors.affiliation: The John A. Hartford Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI; Kuakini Medical Center, Honolulu, HI.
authors.forename: Kamal
authors.initials: K
authors.lastname: Masaki
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001213:Asian; D015992:Body Mass Index; D015897:Comorbidity; D006254:Hawaii / Q000453:epidemiology; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D007564:Japan / Q000208:ethnology; D008137:Longitudinal Studies; D008297:Male; D050177:Overweight / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality*; D015431:Weight Loss
keywords: Aged; Body mass index; Men; Mortality; Rehabilitation; Stroke; Weight loss